Frontbench spokesperson Glenys Thornton on a new report into the funding of mental health treatment in the NHS
“There is one massive inequality within the NHS: the way it treats mental illness as compared with physical illness.”
Thus opens the LSE Centre for Economic Performances report on how mental illness loses out in the NHS. For example, amongst the under 65s almost half of ill health is mental illness. People do not appreciate unless they have the experience, that mental illness can be more debilitating that most chronic physical conditions. Mental pain is as real as physical pain, and often more severe. Yet treatment for mental illness remains a Cinderella service.
Only a quarter of those with mental illness are in treatment, compared with the vast majority of those with physical conditions. The LSE report concludes that more expenditure directed at treating mental illness would almost certainly not cost the NHS extra, because of the link between mental and physical illness. It is estimated that the extra physical healthcare created by untreated mental illness costs the NHS £10bn. If some of that money was spent on psychological therapy, the average improvement of both people’s mental and physical health would be sufficiently great to outweigh the cost of the therapy. Labour recognised this when in government but the most recent Coalition announcements do not reflect a serious will to solve this problem.
The strength of the LSE report is that it looks at the problems and solutions from an economic perspective. It considers how much is wasted in not treating mental illness, and how much can be saved by better use and redirection of existing resources.
Just to take three matters that the report’s authors argue – and which I agree – would make a big difference.
First, Ministers have announced that mental health policies should be implemented on the ground, and made £400m available from 2011-14 to fund Improved Access to Psychological Therapy (IAPT). By 2014, this money should be treating 900,000 people and helping 50% to recover, but many local clinical commissioners are not using the budget for this purpose. The Department of Health needs to make this happen.
Second, although the importance of IAPT roll out is accepted in government documents like No health without Mental Health, the NHS Outcomes Framework 2012/13 made no mention of treatment for the 6 million adults with depression or anxiety, or the 700,000 children with mental health problems. The success rates of the IAPT programme have been carefully measured and are much higher than those for very many physical conditions. The report says there needs to be a commitment to a further 3 years of expansion of IAPT as a cost effective policy that will save money for the NHS in the long term.
Finally, on training and recruitment, the report recommends that mental health should be an automatic component of GP training. The majority of GPs do no training rotation in mental health and there is a strong case for this to be mandatory. And there is a shortfall in the number of psychiatrists for those patients with more complex mental health problems, which if not addressed means we will be heading for a crisis very soon.
This comprehensive and intelligent report asks the government to deliver on this agenda. If Ministers are serious about saving £20bn on existing activities to finance new treatments and expansion, mental health must surely meet the criteria of unmet need. Mental illness accounts for 40% of morbidity rates but receives only 13% of NHS expenditure. This imbalance must be challenged.
Baroness Glenys Thornton is Labour’s Shadow Equalities Minister in the Lords and a former Health Minister